Clinical outcome of various limb salvage surgeries in osteosarcoma around knee: Megaprosthesis, extracorporeal irradiation and resection arthrodesis

摘要

BackgroundWe evaluated the outcome and the survival rate of Limb salvage surgeries (LSSs) in osteosarcoma around knee by using megaprosthesis, ECI autograft, and modified arthrodesis of the knee with metallic plus bone cement (MAMC).MethodsWe reviewed 35 cases of osteosarcoma around the knee that was treated by megaprosthesis, ECI autograft and MAMC from 2012 to 2017. The survival, local recurrence, metastases, complications and functional MSTS score were evaluated for each operation technique. Kaplan-Meier was used to describe the survival rate for each technique.ResultMegaprostheses group had an excellent MSTS score (78.7%), the ECI group (72.3%) and MAMC group (68.4%). Local recurrence occurred in the megaprothesis group (0%), the ECI group (9.1%) and MAMC group (20%). Infection occurred in 3 cases of ECI (13.6%) while only 2 (40%) cases in MAMC group and 1 case (12.5%) in the megaprostheses group. Aseptic loosening occurred in the megaprostheses group 1 case (12.5%) and MAMC 1 case (20%). Metastases occurred in 18.2% of the ECI group compared to 25% of the megaprostheses group and 40% of the MAMC group. The megaprosthesis group had an overall survival rate of 90.9 months, whilst the ECI group is on 94.6 months and the MAMC group was 47.2 months.ConclusionMegaprosthesis showed good-excellent functional outcome and survival rate. ECI that is an option in LSS has good functional outcome as well. Knee arthrodesis with MAMC it is still an option to perform LSS even in the advanced local stage of the disease.